Complete Endovascular Planning

OsiriX and Horos Course · Vascular Surgery

In this presentation, Dr. Daniel Benitti discusses the importance of planning in vascular surgery, especially in endovascular aortic procedures, and how OsiriX becomes a central tool for precise diameter and length measurements, reducing improvisation and avoiding sizing errors (insufficient or excessive oversizing, with risk of endoleak and other complications). The video also includes a discussion of how the axial slice can be misleading when it is not perpendicular to the vessel, producing elliptical images and incorrect measurements. The approach is to control the axes with multiplanar reconstructions (3D MPR) to obtain the true cross-section (the “perfect circle”) and, to measure length, to use the MIP technique (increasing the slice thickness) after aligning the vessel axis. Main topics covered Why axial measurements can be wrong when the vessel is cut obliquely Relationship between incorrect measurement and oversizing error (undersizing vs. oversizing) 3D MPR: creating the “vessel plane” (without relying on fixed axial/coronal/sagittal views) Aortic length: limitations of measuring “in a straight line” and why MIP helps in practice Discussion of Centerline and differences between measurements and intraoperative reality Importance of reducing contrast and radiation through detailed prior planning Demonstration/concept of identifying the artery of Adamkiewicz in OsiriX for thoracic planning Practical experience reported: use of small contrast volumes and a planning-guided procedure workflow Present and future of OsiriX: improvements in 3D Curved MPR, virtual angioscopy, the possibility of digital subtraction from CT angiography, and examples of motion control (Kinect) discussed in the presentation Questions and answers: application to the venous system (e.g., Nutcracker/Cockett), limitations in fistulas, the role of planning in secondary procedures, why the Mac platform, FDA-approved versions, OsiriX Pro, TeraRecon, and comments on not replacing planning with physical examination